The effect on abdominal pain of using carbon dioxide for insufflation during endoscopic retrograde cholangiopancreatography (ERCP) has not been investigated.
Dr Bretthauer and colleagues from Norway assessed carbon dioxide insufflation with standard air insufflation.
The researchers compared theses results with respect to the pain experienced during and after ERCP.
|Mean severity of postprocedure pain was reduced with carbon dioxide|
In addition, the team investigated the effect of carbon dioxide insufflation on the partial pressure of carbon dioxide.
A total of 118 consecutive patients who were undergoing ERCP were randomized to carbon dioxide insufflation or to air insufflation during the procedure.
Both the endoscopists and the patients were blinded with regard to the gas used.
Patients rated the intensity of pain experienced on a 100-mm visual analogue scale during ERCP.
The team also asked the patients to evaluated their pain at 1 hour, 3 hours, 6 hours, and 24 hours after the procedure.
The researchers measured transdermal partial pressure of carbon dioxide continuously in all patients during the procedure.
The team found 116 patients eligible for analysis, with 58 in each treatment group.
The team reported that 91 patients responded to the questionnaire.
The researchers noted that mean severity of postprocedure pain was reduced in the carbon dioxide group compared with the air group at all times measured.
Radiographs taken 5 minutes after the procedure showed that abdominal distension was more pronounced in patients in the air insufflation group.
The team observed no differences in partial pressure of carbon dioxide values between the 2 treatment groups.
Dr Bretthauer's team concludes, “Carbon dioxide insufflation during ERCP significantly reduces postprocedural abdominal pain.”
“No side effects were observed.”
“Carbon dioxide should be the standard gas used for insufflation in ERCP.”